Top five low-value actions ID'd in emergency medicine

Top five low-value actions ID'd in emergency medicine

(HealthDay)—The top five tests, treatments, and/or disposition decisions that are of little value in emergency medicine have been identified, according to research published online Feb. 17 in JAMA: Internal Medicine.

Jeremiah D. Schuur, M.D., M.H.S., from the Brigham and Women's Hospital in Boston, and colleagues assembled a technical expert panel (TEP) and conducted a modified Delphi process to identify a top-five list of tests, treatment, and disposition decisions that are of little value and are actionable by clinicians. A four-stage process was used to create the list, which included surveying 283 clinicians from six departments.

The researchers identified 64 low-value items, which were narrowed down to 17 items that all showed a significant positive correlation between benefit and actionability. One item received unanimous TEP support and four received majority support. According to the top-five list: (1) computed tomography (CT) of the cervical spine should not be ordered after trauma for patients who are not considered high-risk and do not meet the National Emergency X-ray Utilization Study low-risk criteria or the Canadian C-Spine Rule; (2) for suspected pulmonary embolism, CT for diagnosis should not be ordered without first determining the patient's pulmonary embolism risk (pretest probability and D-dimer tests if low probability); (3) of the lumbar spine should not be ordered for patients with lower back pain who do not have high-risk features; (4) head CT should not be ordered for patients with mild traumatic head injury who do not meet New Orleans Criteria or Canadian CT Head Rule; and (5) anticoagulation studies should not be ordered for without hemorrhage or suspected clotting disorder.

"Developing and addressing a top-five list is a first step to addressing the critical issue of the value of emergency care," the authors write.

More information: Abstract
Full Text (subscription or payment may be required)
Editorial (subscription or payment may be required)

Related Stories

ATS issues top five 'Choosing Wisely' recommendations

date Oct 29, 2013

(HealthDay)—The top five pulmonology-related issues that physicians and patients should question have been released by the American College of Chest Physicians and American Thoracic Society (ATS) as part ...

Observation in the ER can reduce CT scans in kids

date Aug 06, 2013

The longer a child with minor blunt head trauma is observed in the emergency department, the less likely the child is to require computed tomography (CT) scan, according to the results of a study published online Friday in ...

Recommended for you

Federal appeals court rejects Arkansas' 12-week abortion ban

date 1 hour ago

A federal appeals court struck down a key abortion restriction in Arkansas on Wednesday, agreeing with a lower court judge that it was inappropriate to ban most abortions after the 12th week of pregnancy if a doctor can detect ...

Link between alcohol outlets and assaults

date 5 hours ago

A study exploring the established link between off-premise alcohol outlets and the rate of assaults and injuries in Australia has found that large bottleshops and liquor chains contribute most substantially ...

Mobilising against hypertension in South Africa

date 5 hours ago

Lifestyle-related disease is on the rise in South Africa, including high blood pressure. An ingenious partnership involving Oxford University is putting the nation's extensive mobile phone network to work ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.